“I spent a year in that town, one Sunday.”

I did not sleep well sans mosquito net... it was hot tucked under the sheet for protection from the insect constantly buzzing in my ear. Around 3am I reapplied the deet and that helped me get through the rest of the night. At 9 I went to  Dr. Marita's for a cup of (real) coffee and some home made bread! Thomas and Marita are both mzungo doctors working at BDH. They move around from country to country (Tibet, Cameroon, Tanzania) since they don't have a house or anything else really tying them to Switzerland they said, why not? They have two young children, 2 years and 6 months, and will settle down when the kids get a bit older. Thomas is away for the week but Marita and I had a great conversation over breakfast.

We chatted about the general apathy of the doctors here and how it extends to the families of patients as well, in fact it permeates most of the culture (perhaps my Cultural Values and Development course wasn't as far off as I had thought). She's presenting a case this week of a child who was brought in unconscious, the family tried herbal medicine to cure it before bringing her in to the hospital. Usually one of the 1st things done for a child in this state is a glucose check but everyone shrugged and said that all the glucometers were broken - pole sana. When they finally got the lab work back the blood glucose was 0.4 (side note - I'm going to assume they're not using mg/dL here but mmol/L which should still have a normal range between 4.2-6.2). When the doctor went to check the glucometers 2 needed new batteries and a few more needed new lancets. All these supplies are available on the campus at the supply closet but no one could be bothered. I don't mean to imply that everyone here is lazy and/or incompetent. There are many smart and motivated doctors and nurses here, unfortunately they can't work all the time. There is a lack of accountability across the whole workforce which just feeds the lack of motivation on the part of workers. How can this be fixed? I understand the need to shut yourself off in the face of so much tragedy, especially as a doctor when patients come to you dying and there really is nothing you can do for lack of equipment or because the case was so advanced by the time the patient arrived. But it seems to me that when the one arrives that you can actually do something about you would work that much harder because finally you can save someone's life and isn't that the reason you become a doctor in the first place? maybe not...

After breakfast Marita obligingly lent me a teach-yourself Swahili book and a copy of a training for the upcoming malaria vaccine study, both of which I've been studying all afternoon. We also agreed that this coming week I would shadow her in the pediatric ward and help her design a new treatment tracking sheet for the patient chart. It is very unlike me to give myself extra work... but at least it should keep me busy! And it gets me in to observe the clinical side of health care at the hospital which was one of my personal goals for the trip.